International Journal of Diabetes and Endocrinology 2016; 1(1): 13-15 http://www.sciencepublishinggroup.com/j/ijde doi: 10.11648/j.ijde.20160101.13 Commentary Safety of the DPP-4 Inhibitor, α-glucosidase Inhibitors, Glitazones and SGLT-2 Inhibitors as Add-on Therapy with Metformin in Medication of Type 2 Diabetes Mellitus Alok Raghav 1, * , Jamal Ahmad 2 , Maaz Ozair 3 , Saba Noor 3 , Zeeshan Ahmad Khan 4 , Brijesh Kumar Mishra 5 1 Rajiv Gandhi Centre for Diabetes & Endocrinology, J. N. Medical College, Aligarh Muslim University, Aligarh, India 2 Diabetes and Endocrinology Super Speciality Centre HIG-1 Avantika, Aligarh U.P., India 3 Rajiv Gandhi Centre for Diabetes & Endocrinology J. N. Medical College, Aligarh Muslim University, Aligarh, India 4 Molecular Rythm Laboratory, Institute of Bio-Resources and Sustainable Development, Takyel, Imphal, Manipur, India 5 Department of Endocrinology, Guru Teg Bahardur Hospital, University of Delhi, New Delhi, India Email address: * Corresponding author To cite this article: Alok Raghav, Jamal Ahmad, Maaz Ozair, Saba Noor, Zeeshan Ahmad Khan, Brijesh Kumar Mishra. Safety of the DPP-4 Inhibitor, α-glucosidase Inhibitors, Glitazones and SGLT-2 Inhibitors as Add-on Therapy with Metformin in Medication of Type 2 Diabetes Mellitus. International Journal of Diabetes and Endocrinology. Vol. 1, No. 1, 2016, pp. 13-15. doi: 10.11648/j.ijde.20160101.13 Received: November 2, 2016; Accepted: December 29, 2016; Published: January 23, 2017 Abstract: Optimal successful management of type 2 diabetes mellitus (T2DM) remains an elusive goal ever. Add on therapies with metformin addressing the prime impaired insulin secretion shows promise in achieving strict and effective glycemic control. The aim of this study was to assess the efficacy of DPP-4 inhibitors, α-glucosidase inhibitors, glitazones and SGLT-2 inhibitors as add-on options with metformin to treat patients with T2DM. The primary outcome of this study was a reduction in diabetes and its associated complication along with strict glycemic control with add-on agents used with metformin. Keywords: Diabetes Mellitus, SGLT-2 Inhibitors, Glitazones, α-glucosidase Inhibitors, Metformin 1. Introduction Despite an emerging therapeutic option, optimal and efficient management of hyperglycemia in T2DM patients remains an elusive goal for researchers and clinicians [1]. Present scenario for the treatment of diabetes mellitus implicatesstep wise approach [2] initiating with lifestyle intervention and metformin as the first line of treatment followed by sequential add-on therapy such as oral antidiabetic drugs (OADs) and basal insulin. Type 2 diabetes is characterized by core defects of insulin secretion and insulin resistance that present itself long before the onset of frank diabetes [3-4]. Therefore early intervention with add-oncombinatorial approach of using OADs is the efficient rational therapeutic approach. Nowadays six classes of OADs presently available in pharmacological sector that includes biguanides (metformin), sulphonylurea (e.g. tolbutamide), thiazolidinediones (e.g pioglitazone), glinidines (e.grepaglinide), DPP-4 inhibitors (e.gsitagliptin, vildagliptin), SGLT2 inhibitors (e.g) and alpha-glucosidase inhibitors (AGIs) (e.gacarbose) [5-6]. The DPP-4 inhibitors belong to gliptins class that are relying on two incretin hormones glucagon-like peptide 1 (GLP-1) and gastric inhibitory polypeptide (GIP). Both of these stimulate insulin secretion from pancreatic beta cells after meals. Moreover, the GLP-1 molecule also additionally targets the post prandial hyperglycemia. However, GLP-1 and GIP has short half-lives and can’t be implicated as such as pharmacological agents so DPP-4 inhibitors were used an alternative of both. The best studies DPP-4 inhibitors are sitagliptin and vildagliptin. Another class of AGIs inhibits the number of alpha-glucosidase enzymes (e.g maltase), which is devoid of pancreatic-centred mechanism action. It consequently delayed